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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the last decade several studies of cerebral blood flow (CBF) and metabolism in the acute phase of head injury have been published. It is the aim of this review to describe the dynamic changes in CBF, cerebral metabolic rate of oxygen (CMRO2), cerebral autoregulation (CA), and reactivity to PaCO2 and barbiturate (metabolic reactivity) in the acute phase after severe head injury and to discuss the therapeutical consequences with reference to prolonged artificial hyperventilation, hypothermia, barbiturate sedation, and mannitol therapy. On the basis of present knowledge concerning cerebral circulation and its regulation, the author reviews the literature concerning methodology for experimental and clinical CBF measurements and regulation of CBF and cerebral oxygen uptake. Emphasis is placed on studies of the effect of body temperature (hypothermia) as a therapeutic tool in the control of cerebral metabolism, blood flow, and intracranial pressure. Although hypothermia significantly reduces cerebral metabolism and blood flow, the effect of hypothermia on cerebral blood flow, metabolism, ICP, and outcome after acute head injury has never been investigated in clinically controlled studies. Experimental and clinical studies concerning sensitivity of CBF for changes in PaCO2 are reviewed. The normal CO2 reactivity defined as absolute (delta CBF/delta PaCO2) and relative (% change CBF/delta PaCO2) or delta in CBF/PaCO2 mm Hg are mentioned. In awake normocapnic man the relative CO2 reactivity averages 4%/mm Hg and the absolute CO2 reactivity 2ml/mm Hg. Uncontrolled prospective studies show a therapeutic effect of artificially prolonged hyperventilation on outcome. Only one preliminary controlled study indicates that the outcome is poorer and recovery prolonged. Nevertheless, in the acute phase of HI, artificial hyperventilation is used routinely for control of intracranial hypertension and during the intensive care management of the patients. The steal and inverse steal phenomena are reviewed. Although of considerable theoretical interest these phenomena are without clinical significance in patients with head injury, unless clinical CBF measurements are performed. The frequency of the inverse steal phenomenon in studies of rCBF with a 16-channel Cerebrograph (intraarterial approach) is found to be about 10%. During prolonged hyperventilation experimental studies and clinical studies of apoplexy show an adaptation of CBF and CSF-pH and bicarbonate.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cerebral blood flow in acute head injury. The regulation of cerebral blood flow and metabolism during the acute phase of head injury, and its significance for therapy. 227 29

In the paper are presented the results of total enzyme activity investigation: GOT, GPT, LDH and CPK, and of the CPK isoenzymes in the cerebrospinal fluid of 148 examinees and in the serum of 67 examinees with an acute stroke, who were treated at the Intensive Care Unit of the Department of Neurology and Institute of Neuropathology, Clinical Medical center "Rebro". The aim was to determine the reliability of the applied methods in the diagnosis of cerebrovascular diseases, particularly in the differential diagnosis of cerebral hemorrhage, ischemia and subarachnoidal hemorrhage. The highest frequency of pathologic findings of the tested enzymes in the whole group of patients with CVA was obtained in the determination of the CPK total activity assessment, then followed the assessments of LDH activity, isoenzyme CPK profile, GOT and finally GPT activity. A larger number of pathologic findings of all mentioned enzymes and CPK isoenzymes was found in the group of patients with ICH. In the patients with ICH and ISI, who survived stroke a higher incidence of normal findings of the total enzymic activities was found, while in those who died from ICH a higher incidence of pathologic findings could not be established. The correlations between the total CPK activity in the serum and in the cerebrospinal fluid does not exist, as well as the correlation between the CPK isoenzyme profile in the serum and CSF.
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PMID:Study of serum and cerebrospinal fluid enzymes in diagnosis and differential diagnosis of cerebrovascular diseases. 229 Apr 71

During the past 25 years, 77 giant pituitary adenomas have been treated surgically, including suprasellar extensions of type C in 66 cases and of type D in 11 cases. Non-secreting adenomas were present in 53 and secreting adenomas in 24 cases. All patients except 3 presented with significant visual field defects; including bitemporal hemianopia, superior quadranopia or unilateral temporal hemianopia, contralateral blindness in 73% of the cases, and one case with sudden bilateral blindness due to acute pituitary apoplexy. A single transsphenoidal procedure was carried out in 74% of the patients while 11 patients (7%) required re-operations for recurrent or residual tumor. Only 3 patients required a subsequent transcranial procedure. Complications included 1 CSF-leak, 1 empty-sella syndrome and 4 fatal post-operative hematomas. We prefer the transsphenoidal route even in very large or giant pituitary adenomas, since it allows rapid and adequate decompression of the optic nerves and chiasm, avoids major pituitary insufficiency in 60% of the cases and is associated with low morbidity-mortality rates.
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PMID:Surgical management of giant pituitary adenomas. 231 Oct 19

Serum thyroid hormones were measured in 62 cases of acute cerebrovascular apoplexy. Compared with the control group, T3, FT3 were markedly lowered and rT3, T4 and TSH were significantly increased with lowered T3/rT3 ratio. The patients were divided into two groups, according to whether there was hemorrhage in their CSF. Changes of serum thyroid hormones in cerebral haemorrhage were more remarkable than those observed in cerebral thrombosis. 16 cases with increased T4, FT4 were diagnosed as euthyroid hyperthyroxinemia. It was found that the amount of thyroid hormone changes appeared to be in proportion to the severity of acute cerebrovascular apoplexy. The determination of serum thyroid hormones would be useful in evaluating the severity of the strokes and in studying the thyroid function in acute cerebrovascular apoplexy.
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PMID:[Changes in serum thyroid hormones in acute cerebrovascular apoplexy and their clinical significance]. 239 Aug 78

Intraperitoneal injection of hypertonic glucose solution induced intracranial hemorrhage in rats. Simultaneously determined plasma norepinephrine exponentially increased followed by death. Using in vivo voltammetry, the present study was undertaken to estimate the relationship between neurochemical parameters and intracranial bleedings induced by hypertonic glucose injection. When placed in a solution of dihydroxyphenylacetic acid (DOPAC) and 5-hydroxyindole acetic acid (5-HIAA), electrically pretreated carbon fiber electrodes produced a 3 distinct peaks. Peak 1 and 2 refer to the extracellular fraction of ascorbic acid and DOPAC. Peak 3 refers to that of 5-HIAA. The peaks of the voltammograms obtained in vivo from different areas of the brain are similar to those observed in vitro using DOPAC and 5-HIAA solutions. Electrodes implanted in the ventricular CSF showed that DOPAC increased immediately after glucose injection, while 5-HIAA did not change significantly. When the electrode was inserted into the putamen, 5-HIAA exponentially increased followed by death, whereas DOPAC showed only a small change. It was presumed that the stroke-induced major oxidizable compounds are different in the lateral ventricle and the putamen. These results suggest that during cerebral bleeding, plasma norepinephrine increases accompanied with a potentiation of the central DOPAC and 5-HIAA system in rats.
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PMID:Changes in DOPAC and 5-HIAA after acute cerebral hemorrhage induced by hypertonic glucose solution (i.p.)--in vivo voltammetry study. 241 26

Thirty four patients who had complete ischemic stroke confirmed by neurologic examination, were divided into three groups according to the time elapsed between the first signs of stroke and lumbar puncture: group A, 22-47 h; group B, 48-71 h; group C, 72-96 h. Nineteen patients with multi-infarct dementia (MID) assessed by neurologic and neurophysiologic examinations were also studied. The severity of the neurological deficit was assessed by the Norris rating scale. Nine age-matched subjects without neurologic disease served as controls. Levels of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were determined in lumbar CSF by a fluorimetric method after separation on Sephadex G-10 columns. HVA levels decreased as the length of time after stroke increased and were lower than controls in MID, while 5-HIAA levels were low in group B and MID. Our results in stroke can be interpreted as showing they are the consequence of dopamine and serotonin global depletion in the early phases of brain ischemia. In MID, the CSF changes might reflect not only tissue loss secondary to multiple infarcts but also the persistence of a state of diffuse ischemia.
Stroke
PMID:Homovanillic acid and 5-hydroxyindoleacetic acid modifications in CSF of patients with stroke and multi-infarct dementia. 241 48

In 30 ischemic stroke patients, divided into 2 groups depending on the side of their hemispheric cerebral lesion, the authors evaluated the levels of CSF homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA). The changes of these metabolites in CSF samples collected 3, 14 and 25 days after stroke have been correlated to the clinical course. In both groups, which were similar in respect to the localization of the infarcted area and to the volume of the lesion, the levels of HVA and 5-HIAA increased in the first 2-3 days and gradually declined to normal values in the following 3 weeks, in parallel with the regression of neurological deficits. The increase of HVA and 5-HIAA was statistically significant only in left hemisphere-injured patients. A linear regression analysis between the clinical score values and the CSF levels of the two metabolites at different time-points of observation revealed a significant correlation only for the HVA in the left-lesioned patients.
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PMID:Different patterns of CSF neurotransmitter metabolism in patients with left or right hemispheric stroke. 242

We reported a case of mitochondrial encephalomyopathy with repeated stroke-like episodes. A 33-year-old single male was admitted to our hospital because of stroke-like episodes with visual field defect, hemiplegia and convulsion repeated seven times for the past seven years. There were no abnormalities on the physical examination. He was hallucinative and perseverative and had mental deficiency. Muscle weakness and atrophy were not prominent, and generalized hyporeflexia were present without pathological reflexes. Myoclonus was not observed. Serum CK and blood gas analysis were normal (pH 7.398). Although blood levels of lactate and pyruvate were almost within normal limit, lactate was elevated by 20WATT-15 minutes exercises. On the contrary, the CSF levels of lactate and pyruvate were elevated markedly. CT of the brain revealed the presence of the low density areas in the right occipital and the left frontal lobes. Cranial 4 vessels studies were unremarkable. EEG showed the diffuse slowness with spike and wave complex. CT of the muscles were normal. A specimen obtained from the left biceps brachii muscle showed ragged-red fibers without obvious myogenic or neurogenic changes, and accumulations of abnormal mitochondria with paracrystalline inclusion bodies were observed by electron microscopy. However, mitochondrial abnormalities were not seen in the vessel walls in the biopsied muscle. Activities of complex I + III, II + III, IV in mitochondria were normal. Clinical features of this case were consistent with MELAS. However, this case showed no muscle weakness, short stature and lactic acidosis which characterize MELAS, and the onset of this case was later than those cases that were reported before.
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PMID:[A case of mitochondrial encephalomyopathy characterized by repeated stroke-like episodes]. 250 53

The content of B6, PP and C vitamins was determined in the blood, CSF and urine in 64 patients with ischemic stroke during admission and on the 10-15 and 25-30 days of the disease. Patients with ischemic stroke show a marked deficit of the mentioned vitamins. When vitamins were not included in the complex treatment of stroke their deficit remained, though the general condition of the patients improved.
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PMID:[The vitamin B6, PP and C allowances of patients in the acute period of ischemic stroke]. 252 12

A case is reported illustrating two points: 1. haemorrhage can occur in cerebral infarct even without the use of anticoagulants; 2. this haemorrhage can extend into the subarachnoid space, causing chemical meningitis, and may produce moderately severe low CSF sugar. The importance of this point is emphasised when faced with a stroke patient who develops fever.
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PMID:Hypoglycorrhagia does not necessarily indicate infection. 259 Jun 36


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